Outline

Background

Evidence-based surgical decision making implies the application of valid research findings to clinical practice. The objective of this systematic review is to explore the current status and usage of Cochrane Reviews (CR) in the field of gastrointestinal surgery to support evidence-based decision making.

Methods

Systematic literature search for CRs adressing the following surgical topics: hepato-pancreatico-biliary system, stomach including cardia and the alimentary tract including duodenum, small bowel, large bowel, rectum and anus. The implications for practice and the requests of included CRs were analyzed via the Cochrane Collaboration’s homepage. Multiple CRs focussing the identical clinical question were summarized by meta-analysis (umbrella review).

Results

69 CRs including 1,108 primary studies and 186,425 patients were identified. The systematic review revealed heterogeneous results regarding the covered topics, the amount of included primary studies (mean 16.1; SD 14.7), the proportion of non-randomized studies (mean 3.3; SD 9.4) and the overall number of study patients (mean 2,783; SD 3,501). A definitive treatment recommendation was given in 34 (49.3%) CRs. On average, 1.48 (SD 1.61) surgical CRs were requested per months via the Cochrane Collaboration’s Homepage. 13 CRs evaluating analgesics for postoperative pain relief and 4 analyzing several interventions for the prevention of surgical site infection were included in the umbrella review.

Conclusions

Since the observed availability of CRs as well as their usage is currently low, the awareness of the value of CRs has to be augmented in the field of surgery. Finally, prioritization of special surgical issues and the concept of umbrella reviews which compile multiple CRs focussing a specific clinical question have to be emphasized in the future in order to support the transfer of research findings into daily surgical practice.